Esophageal Hematoma Research Articles

Extrinsic left atrium compression due to intramural esophageal hematoma after TEE for catheter AF ablation mimicking tamponade

Extrinsic left atrium compression due to intramural esophageal hematoma after TEE for catheter AF ablation mimicking tamponade

Spontaneous esophageal submucosal hematoma.

A 57-year-old woman presented to our hospital with chest distension, sore throat and back discomfort beginning the previous day after taking 5 panax notoginseng capsules. She had a history of hypertension for more than 2 years. Physical examination was unremarkable. Blood tests revealed results: A red blood cell count of4.27T/L, a platelet count of 296G/L, a hemoglobin count of 130 g/L (130-175 g/L), and a D-dimer count of0.252 mg/L. Endoscopy showed a longitudinal dark red submucosal hematoma (SH) extending from 20 cm down to 36 cm, with no active bleeding. The next day an enhanced CT of the chest showed uneven thickening of esophageal wall suggestive of intramural esophageal hematoma. A second endoscopy was performed 6 days later, and it showed an esophageal ulcer where the hematoma had been seen at the previous part. The patient was treated with a proton pump inhibitor (PPI) and nutritional support while oral intake was completely prohibited. Her symptoms gradually improved and disappeared. She was discharged one week after the second Upper GI endoscopy when she was able to eat liquid diet. After discharge, she continued the PPI and Kang Fuxin for 2 months. During the 4-month follow up, the symptoms did not recur.

Oesophageal haematoma in a Cairn terrier presenting for impaired swallowing, retching and cervical pain

AbstractA 13‐year‐old spayed female Cairn terrier was referred for surgical resection of a large oesophageal mass. The dog was initially presented to the primary care veterinarian for several days of gagging. The mass was initially diagnosed on thoracic radiographs and confirmed via computed tomography and oesophagoscopy. Endoscopic biopsies were performed that were consistent with oesophagitis. The dog was then referred to The Ohio State University Veterinary Medical Center for surgical resection of the mass. On surgical approach, a small nodule was palpable in the oesophagus; however, a large mass was not found. Oesophagoscopy was repeated intraoperatively, which revealed a small nodule in the same region of the previously described mass. The small nodule was removed, and histopathology was consistent with lymphohistiocytic inflammation and previous haemorrhage, consistent with an oesophageal haematoma. The dog made a full recovery post‐operatively, with continued resolution of clinical signs reported 5 months after surgery.

Submucosal Hematoma of Esophagus Induced by Chewing Betel Nut

Submucosal Hematoma of Esophagus Induced by Chewing Betel Nut

Computed tomography for spontaneous esophageal hematoma: reliable support from diagnosis to recovery

The purpose of the study. To study the possibilities of computed tomography (CT) in the diagnosis of spontaneous hematoma of the esophagus, including in the process of dynamic observation.Materials and methods. A retrospective analysis of CT results in 11 patients with spontaneous esophageal hematoma treated at the N.V. Sklifosovsky Research Institute of SP in the period 2005–2020 is presented. All patients underwent a comprehensive laboratory and instrumental examination, including CT. CT studies were performed with oral and intravenous bolus contrast, primarily at admission and in dynamics.Results. In all cases, according to CT data, acute pathology of the aorta, rupture of the esophagus were excluded and signs of spontaneous hematoma of the esophagus were revealed. CT semiotics of esophageal hematoma was analyzed with quantitative treatment of changes in density, linear dimensions and volume. CT semiotics analysis also revealed the volumetric effect of hematoma on surrounding organs and structures, accumulation of blood in the pleural cavities, and verified signs of infection of hematoma with inflammatory changes in the surrounding paraesophageal tissue. CT data served as the basis for determining the optimal treatment tactics for spontaneous esophageal hematoma. Conservative therapy was the main method of her treatment. CT examination in dynamics allowed timely detection of complications of spontaneous hematoma of the esophagus (hemothorax, perforation of the esophagus, infection of the hematoma) requiring surgical intervention.Conclusion. CT is the method of choice in the diagnosis of spontaneous hematoma of the esophagus, which allows for a clear differential diagnosis with urgent life-threatening conditions. CT data make it possible to justify treatment tactics and assess the dynamics of the pathological process.

Intramural Esophageal Hematoma With Associated Hemothorax

Intramural esophageal hematoma (IEH) is a rare manifestation of esophageal wall injury with nonspecific symptoms. It may be caused by trauma or occur spontaneously. IEH is often discovered on computed tomography or esophagogastroduodenoscopy and is typically managed conservatively with supportive care to allow healing. It is frequently an isolated finding in the esophagus and seldom involves any other organ. We report a rare case of a patient discovered to have an obstructing IEH with associated hemothorax after an unrelated surgical admission.

Rare case of intramural esophageal hematoma associated with betel nut consumption.

A 47-year-old man who experienced sudden retrosternal pain and dysphagia for 2 days was admitted to the emergency room. While his physical examination and laboratory results were unremarkable, results of esophagogastroduodenoscopy revealed a longitudinal, purplish-red, and cystic submucosal emanation throughout the esophagus, fluctuating with respiration ([Fig. 1 a], [Video 1]). Mucosal erosion was noted but without obvious rupture. We therefore suspected an esophageal intramural hematoma.

Abstract 11378: Spontaneous Esophageal Hematoma in Chronically Anticoagulated Atrial Fibrillation

Introduction: Intramural esophageal hematoma is a rare condition presenting with dysphagia, nausea and mid epigastric or retrosternal chest pain. We present a unique case of spontaneous esophageal hematoma in a patient anticoagulated with apixaban for atrial fibrillation. Case presentation: An 88-year-old woman with history of hypertension, hypothyroidism, persistent atrial fibrillation on apixaban presented to emergency department with sudden onset epigastric pain, dysphagia and nausea without vomiting while having dinner. Physical examination was unremarkable except for mild tenderness in the epigastric region. Initial workup including complete blood count, complete metabolic panel, lipase, troponin was unremarkable. EKG showed atrial fibrillation with no ischemic changes. CT chest showed abnormal hyperdense mass-like thickening approximately 4 x 3 x 12 cm involving the mid/distal thoracic esophagus with possible differentials being food bolus, esophageal hematoma or mass. Prothrombin complex concentrate (Kcentra) was given as patient was on apixaban and gastroenterology was consulted for upper endoscopy which showed a large hematoma occupying most of the esophageal lumen at the entire length of esophagus. After family discussion on stroke-versus-bleeding risk with anticoagulation, cardiology recommended holding anticoagulation for at least a month and future evaluation for WATCHMAN device. With stable hemoglobin and gradual advancement to a soft diet, patient was discharged home with repeat endoscopy planned in two weeks. Conclusion: Spontaneous esophageal hematoma, although rare in incidence, should be identified as a differential diagnosis in a patient on anticoagulation presenting with chest pain. Literature shows a higher incidence of this complication in women. Timely diagnosis and management along with discontinuing anticoagulation can significantly lower morbidity and mortality and overall has favorable prognosis.

A Pressing Matter: Compressive Postoperative Hematoma Causing Acute Diastolic Heart Failure

BackgroundCardiopulmonary complications in the postoperative period can lead to significant morbidity and mortality. Many of the complications in the postoperative period occur after discharge from the hospital, and up to 25% of patients will require readmission. In postoperative patients presenting to the emergency department (ED), it is important to consider that postoperative complications can affect a multitude of organ systems, including those that are adjacent to where the surgery was performed. Case ReportWe present the case of a 54-year-old woman presenting to the ED with shortness of breath in the setting of recent Nissen fundoplication revision. Pulmonary angiography was significant for a large hiatal hernia and negative for pulmonary embolism. She was discharged and returned to the ED a few days later due to worsening symptoms. Further diagnostic studies demonstrated an esophageal hematoma causing compression of the left atrium, leading to acute diastolic heart failure. Why Should an Emergency Physician Be Aware of This?It is important to consider alternative etiologies for common complaints in the postoperative patient presenting to the ED. Early involvement of the operative team in the patient's care can assist in directing diagnostic approach and management of the postoperative patient.

IATROGENIC ESOPHAGEAL PLEURAL FISTULA POST-TRANSESOPHAGEAL ECHOCARDIOGRAM: A CASE REPORT

IATROGENIC ESOPHAGEAL PLEURAL FISTULA POST-TRANSESOPHAGEAL ECHOCARDIOGRAM: A CASE REPORT

AN UNFORTUNATE VISIT TO THE DENTIST

AN UNFORTUNATE VISIT TO THE DENTIST

S2352 No Soup for You: The Case of an Intramucosal Hematoma Found During Endoscopy for an Esophageal Food Impaction

Introduction: Esophageal food impaction (EFI) is third most common gastrointestinal emergency, which is commonly associated with obstructive lesions such as peptic strictures and Schatzki rings, eosinophilic esophagitis and rarely motility disorders. Endoscopic therapy is the mainstay option for the management of EFI if medical therapy fails. The most commonly impacted foods include beef, chicken, pork, and undercooked vegetables with liquids rarely causing an impaction. Complications from a prolonged EFI can result in mucosal disruption to an esophageal perforation. We present an unusual case of an esophageal intramucosal hematoma found in a during endoscopic retrieval of an esophageal impaction. Case Description/Methods: An 80-year-old male presented with a 2-hour history of foreign body sensation in his throat that began while eating hamburger meat and soup with potatoes. He began coughing up a large amount of mucus at symptom onset and was unable to finish his meal. He has been unable to swallow solids or liquids. History was significant for esophageal peptic strictures in the past requiring dilations. After 2 doses of glucagon failed to help pass the bolus, the patient underwent endoscopic removal of the esophageal food impaction. During the procedure, food was found in the middle and lower thirds of the esophagus and was subsequently removed with suction cap and rat toothed forceps. The esophagus was tortious and was noted to have decreased and abnormal movement throughout with a moderate stenosis found at the gastroesophageal junction. The middle and lower third of the esophagus had localized severe erythema, suspicious for the presence of intramucosal hemorrhage (Figure). The patient tolerated a diet after endoscopy and discharged home. Discussion: Esophageal food impactions are uncommon and are commonly associated with stricture and rings. Complications from a prolonged food impaction include mucosal disruption however findings of an intramucosal hematoma are rare. Intramucosal hematoma present with chest pain, dysphagia, and hematemesis. This patient presented with dysphagia however had no other pain or episodes of hematemesis. In this patient it is unclear whether his presentation was due to an acute EFI causing an intramucosal hematoma or whether the ingestion of soup caused an intramucosal hematoma resulting in an EFI. Nevertheless, one should take caution during endoscopic evaluation for patients who presented with an EFI.Figure 1.: Localized severe erythema suspicious for intramucosal hemorrhage. (1a., 1b., 1c.), Lower third of the esophagus. (1d.)- Gastroesophageal junction.

Spontaneous oesophageal haematoma with perforation masquerading as cardiac ischaemia.

Spontaneous oesophageal haematoma with perforation masquerading as cardiac ischaemia.

Endoscopic Full Length Mucosa Incision for a Huge Esophageal Hematoma Therapy: The First Clinical Experience.

Endoscopic Full Length Mucosa Incision for a Huge Esophageal Hematoma Therapy: The First Clinical Experience.

Esophageal hematoma associated with transesophageal echocardiography during transcatheter aortic valve replacement in an elderly Japanese woman.

Esophageal hematoma associated with transesophageal echocardiography during transcatheter aortic valve replacement in an elderly Japanese woman.

Transesophageal Echocardiography-Guided Transseptal Left Atrial Access to Improve Safety in Patients Undergoing Pulmonary Vein Isolation.

Background: Endovascular pulmonary vein isolation (PVI) has become an important strategy for rhythm control in patients with symptomatic atrial fibrillation (AF). Transseptal access is a critical step of this procedure and can result in potentially life-threatening complications. This retrospective study evaluates the safety of standardized, transesophageal echocardiography (TEE)-guided transseptal access to the left atrium in consecutive patients who underwent PVI. Methods: After the implementation of a standardized, TEE-guided procedure for transseptal access, the data of 404 consecutive PVI procedures using radiofrequency ablation and 3D-mapping were prospectively collected over 5 years. TEE-guided transseptal punctures were performed on 375 patients undergoing one to three PVIs. The patient cohort was retrospectively analyzed for major and minor complications, fluoroscopy time, fluoroscopy dose and ablation outcomes. Results: No single complication related to transseptal access occurred, affirming the safety of the TEE-guided approach. Fluoroscopy time and fluoroscopy dose decreased significantly after 152 procedures. PVI-related minor complications occurred in 11 procedures (2.6%) and included 10 vascular-access-related complications (2.4%) and 1 TEE-related esophageal hematoma (0.2%), which healed spontaneously. Conclusion: Our single-center study shows that TEE guidance may allow safe transseptal access to the left atrium in patients undergoing PVI.

Spontaneous esophageal hematoma after kidney transplantation

Spontaneous esophageal hematoma is an extremely rare pathological condition, diagnosed mainly in patients with coagulopathy. We present the rarest case report of spontaneous esophageal hematoma, which occurred on the 5th day after allogeneic cadaveric kidney transplantation in a 53-year-old woman. Early diagnosis and treatment helped to achieve complete hematoma regression without complications.

Causes and Management of Esophageal Hematoma: A Review

Intramural hematoma of the esophagus (IHE) or dissecting intramural hematoma is a relatively unusual complication of acute mucosal and submucosal lesions that results in a blood accumulation between the layers of the esophagus. Esophageal hematoma is a rare condition that can develop spontaneously or as a result of trauma, poisoning, or medical intervention. Mallory-Weiss syndrome, Boerhaave syndrome, and IHE are all forms of acute mucosal damage of the esophagus, with IHE being the rarest of the three. In general, esophageal traumatic damage, including traumatic penetration and perforation, is uncommon, making IHE incidence and prevalence difficult to measure. Although most esophageal hematomas are asymptomatic, they can cause significant chest discomfort, dysphagia, and hematemesis. Esophageal hematomas should be distinguished from Mallory-Weiss tear and Boorhaave's syndrome, which they may closely resemble in such cases. Moreover, cardiovascular and respiratory diseases should be ruled out, therefore further tests such as an electrocardiogram, chest X-ray, and laboratory testing can be useful. The majority of cases resolve with conservative treatments, with symptoms disappearing in 1-2 weeks. NPO, IV fluids, acid suppression, and treatment of coagulopathy are all conservative procedures. This review aims to summarize current evidence on etiology, epidemiology, diagnosis and management of esophageal hematoma.

A close call: intramural oesophageal haematoma presenting with airway compromise.

A close call: intramural oesophageal haematoma presenting with airway compromise.

RESULTS FROM A 52-WEEK, NONINTERVENTIONAL STUDY OF BRAZILIAN INDIVIDUALS WITH SEVERE HAEMOPHILIA A RECEIVING PROPHYLAXIS: RATES OF BLEEDING, FVIII USE, AND QUALITY OF LIFE

Regular prophylaxis with exogenous Factor VIII (FVIII) is recommended for individuals with severe haemophilia A (HA), but standardised data on bleeding, FVIII use, and quality of life (QoL) for this population in routine clinical practice are scarce. In a prospective, multinational, noninterventional study, male participants age ≥18 years with severe HA (FVIII ≤1 IU/dL) receiving prophylactic FVIII were followed for at least 6 months. Bleeding and FVIII use were reported weekly. Annualised bleeding rate (ABR) and FVIII infusion rate were calculated for participants with ≥6 months follow-up and combined with retrospective data from 6 months prior to baseline. Adverse events (AEs) were collected monthly. Participants completed the haemophilia-specific health-related QoL questionnaire for adults (Haemo-QoL-A) at baseline. This abstract presents a sub analysis of the study's Brazilian population. For all 54 Brazilian participants, median (range) age was 27 (18–47) years. For the 41 (76%) Brazilian participants with ≥6 months follow-up, mean (standard deviation [SD]; median) ABR for treated bleeds was 2.42 (4.05; 0.80) bleeds per year and mean (SD; median) annualised FVIII infusion rate was 167.87 (60.22; 155.17) infusions per year. Mean (SD; median) ABRs of treated traumatic, spontaneous, and joint bleeds were 0.90 (1.6; 0.0), 1.52 (3.3; 0.0), and 1.91 (3.29; 0.0) bleeds per year, respectively. Median (range) percentage of follow-up time adherent with prescribed prophylaxis frequency in Brazilian participants was 94.7%(49%-100%). Mean (SD) Haemo-QoL-A total transformed score (0–100) score was 70.3 (15.1) The lowest mean (SD) domain scores (representing lower QoL) in all Brazilian participants were for treatment concern 45.7 (30.85), physical functioning 66.9 (21.33), and consequences of bleeding 68.1 (22.92). AEs were reported in 22 (40.7%) participants, with the most common AEs being haemophilic arthropathy, nasopharyngitis, and synovitis, each reported in 2 (3.7%) Brazilian participants. Two serious AEs (oesophageal haemorrhage and haematoma) were reported, each by single participant (1.9%). Despite high prophylaxis adherence, participants reported breakthrough spontaneous and joint bleeding and impaired physical functioning. Additional haemostatic options for severe HA are needed.